Healthcare Provider Details

I. General information

NPI: 1821001637
Provider Name (Legal Business Name): DRS. WOODARD & SUNDELL, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 CANTRELL RD STE 303
LITTLE ROCK AR
72212-1844
US

IV. Provider business mailing address

11300 CANTRELL RD STE 303
LITTLE ROCK AR
72212-1844
US

V. Phone/Fax

Practice location:
  • Phone: 501-228-5700
  • Fax: 501-228-5702
Mailing address:
  • Phone: 501-228-5700
  • Fax: 501-228-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3352
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number3423
License Number StateAR

VIII. Authorized Official

Name: CINDY SPANGLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-228-5700